Patient with clinical signs of DVT had tachycardia and history of bladder cancer. According to modified Well’s scoring, the probability of pulmonary embolism would be :
**Core Concept**
The modified Well's scoring system is a clinical prediction rule used to estimate the probability of pulmonary embolism (PE) in patients with suspected DVT. This scoring system takes into account various clinical and laboratory parameters to guide further diagnostic testing.
**Why the Correct Answer is Right**
The patient's clinical presentation with DVT, tachycardia, and a history of bladder cancer contributes to a higher score on the modified Well's criteria. **Option B**, which likely represents a score of 4.75 or higher, indicates a high probability of PE. This is because the patient's history of cancer, which increases the risk of clotting, combined with the presence of DVT and tachycardia, a marker of hemodynamic instability, would significantly elevate the score. The modified Well's scoring system allocates points for each of these criteria, with a higher score indicating a greater likelihood of PE.
**Why Each Wrong Option is Incorrect**
* **Option A:** A score of 0 or 1 on the modified Well's criteria would indicate a low probability of PE, which is unlikely given the patient's clinical presentation.
* **Option C:** A score of 3 or 3.5 would indicate a moderate probability of PE, but the patient's history of cancer and tachycardia would likely push the score higher.
**Clinical Pearl / High-Yield Fact**
When using the modified Well's scoring system, remember that a score of 4.75 or higher indicates a high probability of PE, warranting further diagnostic testing such as CT pulmonary angiography.
**Correct Answer:** B.